Kansas Medicaid expansion in doubt despite hospital’s woes

TOPEKA, Kan. (AP) — Advocates are buzzing again about the possibility of extending Kansas' health coverage for the poor because of a Topeka hospital's potential demise but could struggle to attract the last few votes from reluctant Republican legislators to overcome GOP Gov. Sam Brownback's opposition.

Supporters of expanding Medicaid under former President Barack Obama's signature health care law must persuade a few more GOP lawmakers that it can be done without extra costs to the cash-strapped state. Advocates count on having to override a Brownback veto and are shy of the two-thirds majorities needed in both chambers.

They were energized by the recent announcement that the owner of the Catholic nonprofit St. Francis hospital in Topeka plans to stop operating it this summer, whether it finds a buyer or not. They warned that without Medicaid expansion in the GOP-led state, hospitals will suffer financially because of uncompensated care.

But when the Republican-led Legislature returns May 1 from its annual spring break, the last few holdouts would be GOP lawmakers skeptical of projections from advocates that expanding Medicaid would be a net financial plus for the state. The state still faces collective budget shortfalls totaling $889 million through June 2019.

"My job, I believe, is to protect the financial security of the state," said freshman state Sen. Larry Alley, a Winfield Republican. "When you're in that deep of a hole, it's time to stop digging."

Medicaid covers about 377,000 poor, disabled and elderly Kansas residents but not poor adults without children. Lawmakers approved a bill last month that would have extended coverage to as many as 180,000 poor adults, with Democrats unanimously supporting it and Republicans split. Brownback vetoed it and supporters failed to override his action.

"They can't accept the fact that they lost," said House Health and Human Services Committee Chairman Dan Hawkins, a Wichita Republican who opposes expansion. "This is just going to suck more air out of the room."

The 2010 federal Affordable Care Act championed by the former Democratic president encouraged states to expand Medicaid by promising to pay most of the cost. Brownback's administration still projects extra expenses of at least $66 million over the next two years for the state, and some allies believe the figure could be higher.

"Most of my constituents are for expansion if we've got a method of paying for it," said state Rep. Shannon Francis, a Republican from Liberal, who so far has voted no.

The pro-expansion Alliance for a Health Kansas says 31 hospitals in Kansas are financially vulnerable because the state hasn't expanded Medicaid.

The 378-bed St. Francis hospital's owner, Denver-based SCL Health, said the lack of an expansion contributed to its financial problems. President and CEO Mike Slubowski said expansion would make a "meaningful" difference but, "It would not close the entire gap."

Spotlighting St. Francis' problems hasn't persuaded some Republican lawmakers, including Alley. A local St. Francis board member, Dr. Jim Owen, the chairman of the hospital's radiology department, said SCL Health's management is to blame for the facility's woes.

Freshman state Rep. Greg Lakin, a Wichita Republican and physician, said it's wrong to claim that Medicaid will solve hospitals' problems.

"There's a host of other factors," he said. "All these small-town hospitals — they're trying to survive on an antiquated medical model."

Advocates doubt they can draft a new plan that's acceptable to Brownback and are focusing instead on building veto-proof majorities.

"I'm not convinced that we can get there yet," said pro-expansion state Rep. Susan Concannon, a Beloit Republican.

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